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Cardiovascular Disease Risk Among Cancer Survivors: The Atherosclerosis Risk In Communities (ARIC) Study.

TitleCardiovascular Disease Risk Among Cancer Survivors: The Atherosclerosis Risk In Communities (ARIC) Study.
Publication TypeJournal Article
Year of Publication2022
AuthorsFlorido R, Daya NR, Ndumele CE, Koton S, Russell SD, Prizment A, Blumenthal RS, Matsushita K, Mok Y, Felix AS, Coresh J, Joshu CE, Platz EA, Selvin E
JournalJ Am Coll Cardiol
Volume80
Issue1
Pagination22-32
Date Published2022 Jul 05
ISSN1558-3597
KeywordsAdult, Atherosclerosis, Cancer Survivors, Cardiovascular Diseases, Coronary Disease, Female, Heart Failure, Humans, Incidence, Male, Middle Aged, Neoplasms, Prospective Studies, Risk Factors, Stroke
Abstract

BACKGROUND: More than 80% of adult patients diagnosed with cancer survive long term. Long-term complications of cancer and its therapies may increase the risk of cardiovascular disease (CVD), but prospective studies using adjudicated cancer and CVD events are lacking.

OBJECTIVES: The aim of this study was to assess the risk of CVD in cancer survivors in a prospective community-based study.

METHODS: We included 12,414 ARIC (Atherosclerosis Risk In Communities) study participants. Cancer diagnoses were ascertained via linkage with state registries supplemented with medical records. Incident CVD outcomes were coronary heart disease (CHD), heart failure (HF), stroke, and a composite of these. We used multivariable Poisson and Cox regressions to estimate the association of cancer with incident CVD.

RESULTS: Mean age was 54 years, 55% were female, and 25% were Black. A total of 3,250 participants (25%) had incident cancer over a median 13.6 years of follow-up. Age-adjusted incidence rates of CVD (per 1,000 person-years) were 23.1 (95% CI: 24.7-29.1) for cancer survivors and 12.0 (95% CI: 11.5-12.4) for subjects without cancer. After adjustment for cardiovascular risk factors, cancer survivors had significantly higher risks of CVD (HR: 1.37; 95% CI: 1.26-1.50), HF (HR: 1.52; 95% CI: 1.38-1.68), and stroke (HR: 1.22; 95% CI: 1.03-1.44), but not CHD (HR: 1.11; 95% CI: 0.97-1.28). Breast, lung, colorectal, and hematologic/lymphatic cancers, but not prostate cancer, were significantly associated with CVD risk.

CONCLUSIONS: Compared with persons without cancer, adult cancer survivors have significantly higher risk of CVD, especially HF, independent of traditional cardiovascular risk factors. There is an unmet need to define strategies for CVD prevention in this high-risk population.

DOI10.1016/j.jacc.2022.04.042
Alternate JournalJ Am Coll Cardiol
PubMed ID35772913